Over five million children undergo surgery in the United States each year and, despite recent advances, pain in children following surgery continues to be a significant problem. It is reported that up to 49% of children suffer clinically significant pain while in hospital and this pain is overwhelmingly under treated. Pharmacological methods such as opioids and non-steroidal anti-inflammatory agents are generally considered the first line of postoperative pain management. It is well documented, however, that pain is a complex, multidimensional condition that can not be optimally treated by medication alone. Instead, it is necessary to attend to nonpharmacological methods of addressing pain. Changing behaviors of healthcare personnel and parents in response to children's pain has been an effective intervention in procedural pain settings (e.g., immunizations), but little is known about the relations between adult behavior and children's pain in postoperative settings. There are distinct differences between the procedural and postoperative environments that undoubtedly influence the relations between adult behaviors and children's pain. For example, postoperative pain is of a longer duration than procedural pain and parents and children generally have less experience in perioperative environments than in primary care. To develop effective interventions that address adult behavior, it is of utmost importance to first empirically identify the specific parent and health-care personnel behaviors that increase or decrease children's postoperative pain. This will be achieved by obtaining a postoperative sequential process-oriented view of parent-child-health care provider behavioral interactions and by using robust sequential analysis techniques. Primary aims of the study are to identify specific parent and healthcare provider behaviors that influence children's postoperative pain. As a secondary aim, we will identify child characteristics (e.g., age) that may moderate the influence of parent and healthcare provider behaviors on children's postoperative pain. Identification of behavioral interaction patterns that influence children's postoperative pain will facilitate the development and evaluation of evidence-based training programs for parents and healthcare providers'in postoperative pain management. PUBLIC HEALTH RELEVANCE: At the conclusion of the study described in this application, we will have identified specific parental and healthcare provider behaviors that are associated with increased or decreased pain immediately following surgery and at home. This information will allow us to develop data-driven behavioral preparation programs that will teach parents, nurses, anesthesiologists and surgeons in how to reduce children's pain in the postoperative process. This newly developed, low-cost, parental and healthcare provider preparation program can be widely adaptable to nearly any medical facility in the United States.